Family health file template

Family Health File

Date: Date

Keep it somewhere safe and share it only with care providers.

Family members

| No. | Name | Date of Birth | Blood Type | Chronic Conditions | Medicines | Allergies |

| --- | --- | --- | --- | --- | --- | --- |

| 1 | Name 1 | Date of Birth 1 | Blood Type 1 | Chronic Conditions 1 | Medicines 1 | Allergies 1 |

| 2 | Name 2 | Date of Birth 2 | Blood Type 2 | Chronic Conditions 2 | Medicines 2 | Allergies 2 |

| 3 | Name 3 | Date of Birth 3 | Blood Type 3 | Chronic Conditions 3 | Medicines 3 | Allergies 3 |

| 4 | Name 4 | Date of Birth 4 | Blood Type 4 | Chronic Conditions 4 | Medicines 4 | Allergies 4 |

| 5 | Name 5 | Date of Birth 5 | Blood Type 5 | Chronic Conditions 5 | Medicines 5 | Allergies 5 |

| 6 | Name 6 | Date of Birth 6 | Blood Type 6 | Chronic Conditions 6 | Medicines 6 | Allergies 6 |

Vaccines and check-ups

| No. | Name | Vaccine or Check-up | Date | Next Due |

| --- | --- | --- | --- | --- |

| 1 | Name 1 | Vaccine or Check-up 1 | Date 1 | Next Due 1 |

| 2 | Name 2 | Vaccine or Check-up 2 | Date 2 | Next Due 2 |

| 3 | Name 3 | Vaccine or Check-up 3 | Date 3 | Next Due 3 |

| 4 | Name 4 | Vaccine or Check-up 4 | Date 4 | Next Due 4 |

| 5 | Name 5 | Vaccine or Check-up 5 | Date 5 | Next Due 5 |

| 6 | Name 6 | Vaccine or Check-up 6 | Date 6 | Next Due 6 |

Care providers

| Item | Details |

| --- | --- |

| Family Doctor | Family Doctor |

| Health Centre | Health Centre |

| Insurer and Policy Number | Insurer and Policy Number |

| Emergency Numbers | Emergency Numbers |

Head of Household: Head of Household